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The Development of Alcohol Use Disorder: The Overlooked Epidemic

Alcohol abuse, a historical public health concern, is gaining increased interest among medical professionals and analysts. Developing assessments are unveiling the significance of our country’s alcohol crisis despite overshadowing drug epidemics.

An estimated 88,000 people die from alcohol-related causes annually, which makes alcohol the third leading preventable cause of death in the United States.1 The prevalence of alcohol in our society is generating alarming statistics of abuse and death that can’t be ignored. According to the 2015 National Survey on Drug Abuse and Health, 15 million adults over the age of 18 and 600,000 of 12-17-year-olds have an alcohol use disorder.1

Alcohol Use Disorder (AUD) is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.2 AUD diagnosis is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its severity is categorized from mild to moderate, or severe. In efforts to identify an individual suffering from AUD the following symptoms may be present:

  • Inability to limit the amount of alcohol consumed
  • An increased time limit for drinking, getting alcohol, or recovering from alcohol use.
  • Feeling a strong craving or urge to drink alcohol.
  • Failing to fulfill major obligations at work, school, or home due to repeated alcohol use.
  • Eliminating or reducing social and work activities, or hobbies
  • Developing a tolerance to alcohol, causing an increased need for more to feel its effect or experiencing a reduced effect from the same amount.
  • Subjected to withdrawal symptoms—such as nausea, sweating, and shaking when not drinking and often drinking to avoid these symptoms.3

AUD is more prone to develop during an individual’s early to mid-adult life, although the onset of the disorder can begin at any age. Certain risk factors can generate hazardous drinking behaviors including:

  • Steady Drinking-drinking too much on a regular basis
  • A Premature Introduction to Alcohol-putting individuals at a higher risk for AUD
  • Family History-influenced genetic variables
  • Mental Health-disorders including anxiety, depression, schizophrenia, or biopolar3

The identification process of AUD is an initial step in addressing a multi-faceted disorder—untreated AUD can lead to long-term health complications ranging from:

  • liver disease, digestive, and heart problems
  • diabetes complications
  • sexual function and menstruation issues
  • eye problems
  • birth defects
  • bone damage
  • neurological complications
  • weakened immune system
  • increased risk of cancer
  • medical and alcohol interactions3

Alcohol is currently a regulated and licit substance in the United States; therefore, it is imperative to adhere to the safe drinking recommendations put forth by health organizations monitoring its usage. According to the Center for Disease Control (CDC), the recommended consumption of alcohol for women is up to 1 drink a day and for men, up to 2 drinks a day.4 If you are under the age of 21, may be pregnant, or have other health problems —abstaining from drinking is strongly advised. In efforts to elaborate on moderating your drinking, understanding what constitutes a “drink” is crucial.

Defining A “Drink”

  • 12-ounces of beer (5% alcohol content)
  • 8-ounces of malt liquor (7% alcohol content)
  • 5-ounces of wine (12% alcohol content)
  • 1.5-ounces of 80 proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey)4

Binge Drinking

Binge drinking is defined as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This type of intoxication generally occurs when men consume 5 or more drinks or women consume 4 or more drinks in 2 hrs.5

Heavy Drinking

Heavy alcohol use is defined as binge drinking on 5 or more days within a month period.5

An Alcohol Epidemic

The depth of AUD in comparison to other national emergency drug epidemics has often gone underestimated, but in 2016, deaths caused by alcohol were more than double those involving opioids.6  The American Academy of Pediatrics (AAP), recommends adopting universal substance abuse screening, brief intervention, and referrals to treatment.6 Identifying adolescents who are at high risk for developing AUD by utilizing screening tools can help accurately predict problematic drinking behaviors. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), have recently developed a two-question alcohol screening designed for middle school and high school students asking the following:

Middle School

  1. Do you have any friends who drank beer, wine, or any alcohol in the past year?
  2. How about you? In the past year how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?

High School:

  1. In the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?
  2. If your friends drink, how many drinks do they drink on an occasion?7

The Importance of Utilizing Alcohol Assessment Tools

Administering evaluative tools in efforts to properly assess risky drinking behaviors can be a useful tactic. However, self-report reliability can become questionable –utilizing additional evidence-based measurements can assist in depicting the true magnitude of one’s drinking behaviors. Several studies have reported difficulties in measuring alcohol-related dependence using self-reporting tools, due to misinterpretation by respondents, lack of specificity, and misperception of AUD symptoms such as after-effects and acute intoxication.8 As a leading forensic toxicology laboratory, we provide alcohol biomarker testing to assist in identifying at-risk drinking behaviors. Our laboratory offers alcohol biomarkers in several specimen types including:

Newborn:

  • Meconium-Fatty Acid Ethyl Ester (FAEE)-window of detection up to approximately 20 weeks prior to collection. (i.e., Birth)
  • Umbilical Cord-Ethyl Glucuronide (EtG)-window of detection up to approximately 20 weeks prior to collection. (i.e., Birth)
  • Blood– Phosphatidylethanol (PEth)-window of detection is up to approximately 2-4 weeks prior to collection.

Adult/Child:

  • Fingernail-Ethyl Glucuronide (EtG)-window of detection is up to approximately 3 months prior to collection.
  • Hair-Ethyl Glucuronide (EtG)-window of detection is up to approximately 3 months prior to collection.
  • Blood-Phosphatidylethanol (PEth)-window of detection is up to approximately 2-4 weeks prior to collection.
  • Urine-Ethyl Glucuronide/Ethyl Sulfate (EtG/EtS) and ethanol-window of detection is up to approximately 2-3 days prior to collection.

An estimated 16 million people in the United States have AUD.2 Incorporating detection methods to assist in identifying individuals exhibiting indicators of destructive drinking can create an effective awareness about AUD –a crisis that affects so many of us today.  

References:

  1. “Alcohol Facts and Statistics.” (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
  2. “Alcohol Use Disorder.” (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
  3. “Alcohol use disorder.” (2018, July 11). Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
  4. CDC – “Fact Sheets-Alcohol Use And Health” – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
  5. CDC – “Fact Sheets-Binge Drinking” – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
  6. Hadland, S. E., Knight, J. R., & Harris, S. K. (2019, March 01). “Alcohol Use Disorder: A Pediatric-Onset Condition Needing Early Detection and Intervention.” Retrieved from https://pediatrics.aappublications.org/content/143/3/e20183654
  7. Spirito, A., Bromberg, J. R., Casper, C., Chun, T. H., Mello, M. J., Dean, M., & Linakis, J. G. (2016, September 22). “Reliability and Validity of a Two-Question Alcohol Screen in the Pediatric Emergency Department.” Retrieved April 3, 2019, from https://pediatrics.aappublications.org/content/pediatrics/138/6/e20160691.full.pdf
  8. Iglesias, K., Sporkert, F., Daeppen, J., Gmel, G. and Baggio, S. (2018). Comparison of self-reported measures of alcohol-related dependence among young Swiss men: a study protocol for a cross-sectional controlled sample. [online] Available at: https://bmjopen.bmj.com/content/8/7/e023632 [Accessed 3 Feb. 2020].